[Phenomenology of motor crisis in non-epileptic patients with psychogenic crises]. / Fenomenología crítica motora en pacientes no epilépticos con crisis psicógenas.

INTRODUCTION: Recognition of different ictal motor patterns in psychogenic seizures may be useful in terms of differentiation from epileptic seizures and may also improve understanding the underlying psychopathology. OBJECTIVE: To outline recognizable ictal motor patterns that may help to distinguish psychogenic motor seizures from epileptic convulsive episodes. PATIENTS AND METHODS: Chart review from 54 patients with motor psychogenic seizures and no clinical or EEG evidence of concomitant epilepsy. RESULTS: Only 5 patients (9.2%) experienced more than one ictal motor pattern along their illness. Categorization into four subtypes according to ictal motor behaviour was possible in all other patients: psychogenic seizures with flaccid unconsciousness (32.6%), combativeness (32.6%), a hypermobile subtype (24.4%) as defined by the presence of intentional movements or slow rhythmic oscillations of a segment or the entire body, and rigidity (10.2%). CONCLUSIONS: Many psychogenic motor seizures consistently present with recognizable motor phenomena which may be readily identified providing the availability of a reliable witness. Psychogenic seizures as presented spontaneously in a general neurology setting may differ from those reported in biased referrals to video-EEG laboratories. Recognition of characteristic patterns may help differentiation from tonic-clonic convulsions, avoid unnecessary examinations, and may provide insights into their underlying psychopathological mechanisms.

Valproate prevents the recurrence of absence status.

We assessed the value of valproate in the prevention of recurrent attacks of absence status in 25 patients. Eighteen patients had primary generalized epilepsy with a mean frequency of attacks of absence status of 5.7 per year. After a mean follow-up period of 4.4 years, the attack frequency was reduced to 0.6 per year (p less than 0.0005); 14 patients had no recurrence, 3 had rare attacks with noncompliance, and 1 had an incomplete response probably due to gastrointestinal intolerance. Patients with evidence of generalized cerebral damage (n = 2) or with EEG evidence of focalization (n = 5) did not respond as favorably. Valproate is the drug of choice for the prevention of recurrence of absence status. Moreover, the response can be predicted on the basis of the electroclinical subtype of absence status.

Meige's syndrome: acute and chronic responses to clonazepan and anticholinergics.

Relief of blepharospasm was achieved with clonazepan (CNZ, 1 mg i.v.) and benzhexol (BH, 5 mg i.m.) by acute parenteral administration in 5 cases of Meige's syndrome. Improvement was greater with CNZ, mean value on a quantitative scale 100%, than for BH (84.1%). Both drugs were less effective on the associated oromandibular dystonia (OMD) observed in 3 of the cases, relief again being greater when using CNZ (87.3%) compared to BH (58.3%). Intravenous administration of CNZ predicted the response to prolonged oral medication (6 mg/day) in 3 of the cases. Though both blepharospasm and OMD are thought to represent focal dystonia at different body sites, the extent of improvement achieved with these drugs at the dosage employed differed markedly.